BACKGROUND Humeral shaft fractures are common and vary by age,with high-energy trauma observed in younger adults and low-impact injuries in older adults.Radial nerve palsy is a frequent complication.Treatment ranges f...BACKGROUND Humeral shaft fractures are common and vary by age,with high-energy trauma observed in younger adults and low-impact injuries in older adults.Radial nerve palsy is a frequent complication.Treatment ranges from nonoperative methods to surgical interventions such as intramedullary K-wires,which promote faster rehabilitation and improved elbow mobility.AIM To evaluate the outcomes of managing humeral shaft fractures using closed reduction and internal fixation with flexible intramedullary K-wires.METHODS This was a retrospective cohort study analyzing the medical records of patients with humeral shaft fractures managed with flexible intramedullary K-wires at King Abdulaziz Medical City,using non-random sampling and descriptive analysis for outcome evaluation.RESULTS This study assessed the clinical outcomes of 20 patients treated for humeral shaft fractures with intramedullary K-wires.Patients were predominantly male(n=16,80%),had an average age of 39.2 years,and a mean body mass index of 29.5 kg/m^(2).The fractures most frequently occurred in the middle third of the humerus(n=14,70%),with oblique fractures being the most common type(n=7,35%).All surgeries used general anesthesia and a posterior approach,with no intraoperative complications reported.Postoperatively,all patients achieved clinical and radiological union(n=20,100%),and the majority(n=13,65%)reached an elbow range of motion from 0 to 150 degrees.CONCLUSION These results suggest that intramedullary K-wire fixation may be an effective option for treating humeral shaft fractures,with favorable outcomes in range of motion recovery,fracture union,and a low rate of intraoperative complications.展开更多
BACKGROUND Supracondylar humeral fractures are among the most common paediatric injuries.Displacement and consequent need for reduction impose operative treatment.Restoration of the anatomy of the distal part of the h...BACKGROUND Supracondylar humeral fractures are among the most common paediatric injuries.Displacement and consequent need for reduction impose operative treatment.Restoration of the anatomy of the distal part of the humerus prevents deformities and functional disorders of the elbow and upper limb.Stable K-wire fixation can be succeeded either by closed or open reduction method.AIM To investigate the safety and efficacy of open reduction method in the operative treatment of Gartland type III and IV supracondylar humeral fractures in children.METHODS We retrospectively studied 131 cases of paediatric supracondylar humerus fractures of Gartland type III-IV treated operatively by open reduction and pinning between 2001 and 2023 in our department.All patients underwent clinical and radiological examination recording elbow range of motion,function and deformity.RESULTS The standard lateral approach was carried out in all patients while in 47 cases(35.9%)additional medial approach was used.Average follow-up time was 5.4 years(1-14 years).Fracture healing was completed at 4-6 weeks.The average operative time was 50 min(range:37-75 minutes,SD:11.307)and the average duration of radiation exposure based on image intensifier usage time was 20 seconds(range:7-45 seconds,SD:9.864).No infections or iatrogenic neurovascular complications were recorded and the functional outcome regarding range of motion,Patient-Reported Outcome Measures(Disabilities of the Arm,Shoulder,and Hand questionnaire,Mayo Elbow Performance Scores)at 2-year follow-up was satisfying.CONCLUSION Open reduction and K-wire fixation provide very satisfactory outcome in supracondylar fractures of the humerus in children with reduced radiation burden.Moreover,the risk of neurovascular injuries due to manipulations of closed reduction,is minimized while complications related to surgical approaches are insignificant provided there is expertise.展开更多
Operative management of humeral shaft fractures demonstrates superior early functional recovery(6-month Disabilities of the Arm,Shoulder,and Hand scores)and significantly lower nonunion rates(63.9%reduction)compared t...Operative management of humeral shaft fractures demonstrates superior early functional recovery(6-month Disabilities of the Arm,Shoulder,and Hand scores)and significantly lower nonunion rates(63.9%reduction)compared to functional bracing,particularly in complex cases,while conservative treatment remains viable for low-demand patients.Surgical techniques,including open reduction internal fixation,intramedullary nailing,and minimally invasive plate osteosynthesis,offer trade-offs between anatomic precision and complication risks(e.g.,radial nerve injury vs rotator cuff damage),with over 90%of radial nerve injuries resolving spontaneously.Ultrasound-guided diagnosis(89%sensitivity,95%specificity)optimizes decision-making for nerve entrapment.Individualized treatment selection,prioritizing fracture complexity and patient needs,is critical to balance accelerated rehabilitation with minimized complications.展开更多
BACKGROUND The objective of this study was to evaluate the use of combined parallax-free panoramic X-ray imaging during surgery by enabling the mobile C-arm with minimally invasive plate osteosynthesis(MIPO)in the man...BACKGROUND The objective of this study was to evaluate the use of combined parallax-free panoramic X-ray imaging during surgery by enabling the mobile C-arm with minimally invasive plate osteosynthesis(MIPO)in the management of proximal humeral shaft fractures.AIM To evaluate parallax-free panoramic X-ray images during surgery.METHODS A retrospective series of 17 proximal humeral shaft fractures were treated using combined parallax-free panoramic X-ray imaging during surgery by enabling the mobile C-arm with MIPO.The operating time and radiation exposure time were recorded,and early postoperative physical therapy and partial weight bearing were encouraged.Patients were followed at regular intervals and evaluated radiographically and clinically.RESULTS The mean operating time and radiation time were 73(range,49-95)minutes and 57(range:36-98)seconds,respectively.No complications occurred during the operation.All fractures healed at an average of 16.9(range:15-23)weeks.The average Constant-Murley score for all the patients was 89.5(range:75-100)points.None of the patients showed symptoms of vascular or nerve damage or wound infection.Three months after the operation,none of the patients developed subacromial impingement syndrome.No loosening or fracture of the implants occurred.The frontal and lateral radiographs showed good alignment.CONCLUSION We consider that MIPO with combined parallax-free panoramic X-ray imaging during surgery is an efficient method for treating proximal humeral shaft fractures,and could significantly reduce operative morbidity as well as lower the rate of intra-and postoperative complications.展开更多
Objective To observe the clinical effects of wrist-ankle acupuncture on external humeral epicondylitis. Methods Seventy-two cases diagnosed as external humeral epicondylitis were brought into the study. Horizontal nee...Objective To observe the clinical effects of wrist-ankle acupuncture on external humeral epicondylitis. Methods Seventy-two cases diagnosed as external humeral epicondylitis were brought into the study. Horizontal needling was used at upper area 3, upper area 4 and upper area 5 near wrists with long filiform needles. The frequency was once a day, and a course included 10 times. Results 27 cases got cured, 36 cases were marked effective, 5 cases were effective and 4 cases were failed after 1 course to 5 courses of treatment. The total effective rate was 94.5%. Conclusion Wrist-ankle acupuncture is a simple and effective therapy on external humeral epicondylitis.展开更多
OBJECTIVE:To compare two therapeutic methods:electroacupuncture + massage + blocking therapy,and blocking therapy alone in the treatment of external humeral epicondylitis.METHODS:Eighty-six patients were randomized in...OBJECTIVE:To compare two therapeutic methods:electroacupuncture + massage + blocking therapy,and blocking therapy alone in the treatment of external humeral epicondylitis.METHODS:Eighty-six patients were randomized into two groups with 43 in each. The treatment group received electroacupuncture + massage +blocking therapy, while the control group received blocking therapy only. A course of electroacupuncture treatment included therapy once a day for 10days. There were 10 treatments in a massage course and massage was given once a day, with a1-week interval given before the next course. A course of blocking treatment included therapy once a week, for twototaltreatments,andgenerallyno more than three times. The therapeutic effects were evaluated with the visual analog scale(VAS),grip strength index(GSI) score, and Mayo elbow performance score(MEPS) before treatment and at0, 6, 12, and 24 months after treatment to observe thetotaleffectiverate.RESULTS: In the treatment and control groups before treatment and at 0, 6, 12, and 24 months after treatment, the VAS scores were: 6.5±1.9 and 6.4±1.6; 4.6±1.3 and 4.6±1.7; 4.8±1.3 and 4.8±1.2; 4.6±1.2 and 6.6±1.6; and 6.5±1.6 and 6.5±1.3, respectively. The GSI scores were 63±8 and 63±8; 84±6and82±7;82±7and82±6;84±6and62±8;and64±6 and 64±7, respectively.The MEPS of both groups were65±7and66±8;85±6and84±7;84±5and84±7;80±7and66±6;and65±6and65±7,respectively.The total effective rates of the treatment and control groups at 0, 6, 12, and 24 months after treatment were 87.5% and 85.0%; 85.0% and 82.5%;80.0% and 12.5%; and 2.5% and 5.0%, respectively.Compared with the treatment group, the control group had greater joint function, better the rapeutic effect, and lower pain intensity(P<0.01), indicating a high recurrence rate in the 12th month after treatment.There were no differences inVAS, GSI, or MEPS at 0, 6, and 24 months after treatment(P>0.05)betweenthetwogroups.CONCLUSION: We found that both methods were effective for external humeral epicondylitis. After 6months of treatment,the effects were good in both groups. However, in the 12th month, the control group had a relatively severe relapse. After 24months, both groups relapsed. The effect of electroacupuncture, massage, and blocking therapy used in combination lasted longer, delaying the recurrence of the disease.展开更多
Objective:To observe the clinical effect of electroacupuncture(EA)at Zhouling(Extra)and Ashi points in combination with blood-letting cupping for the treatment of external humeral epicondylitis(EHE).Methods:Thirty EHE...Objective:To observe the clinical effect of electroacupuncture(EA)at Zhouling(Extra)and Ashi points in combination with blood-letting cupping for the treatment of external humeral epicondylitis(EHE).Methods:Thirty EHE patients were treated with EA at Zhouling(Extra)and Ashi points in combination with blood-letting cupping,once every 2 days,twice a week,4 times as one course of treatment,and2 successive courses of treatment were given.Before treatment,after 1 course of treatment,and after 2 courses of treatment,the visual analogue scale(VAS)score and Mayo elbow performance score(MEPS)were adopted to evaluate the curative effect.Results:Before treatment,the VAS score of patients was 7.81±1.39.After 1 course of treatment and after 2 courses of treatment,it was 4.77±1.56 and 2.95±1.23 respectively,lowered than before treatment,and the difference was statistically significant(both P<0.01).Before treatment,the Mayo score of patients was 32.17±19.31.After 1 course of treatment and after 2 courses of treatment,it was 47.39±19.85 and85.21±20.47 respectively,increased than before treatment,and the difference was statistically significant(both P<0.01).Of the 30 patients,5 were cured,accounting for 16.67%;14 cases obviously effective,accounting for 46.67%;8 cases effective,accounting for 26.67%;3 cases ineffective,accounting for 10.00%,and the total effective rate was 90.00%.Conclusion:EA at Zhouling(Extra)and Ashi points and blood-letting cupping used in combination are remarkably effective in the treatment of EHE,being worthy for popularization.展开更多
Restoration of fracture alignment by osteotomy is crucial for the management of humeral nonunion. In the present study, we introduced a new way of osteotomy (Z-shaped) in treating humeral shaft nonunion secondary to f...Restoration of fracture alignment by osteotomy is crucial for the management of humeral nonunion. In the present study, we introduced a new way of osteotomy (Z-shaped) in treating humeral shaft nonunion secondary to failed plate osteosynthesis. Clinical data of 24 patients with humeral shaft nonunion following implant failure (from 2010 to 2014) were retrospectively evaluated. These patients underwent Z-shaped osteotomy in revision surgery after the initial surgery, plate osteosynthesis, was failed. Outcomes were evaluated using visual analogue scale (VAS) and Constant and Murley score. Repeated analysis of variance (ANOVA) was used for statistical analysis. Patients were followed up for a minimum of 24 months (26.83±4.33 months). The operative time was 102.33±10.16 min, and hospital stay averaged 9.75±2.13 days. All patients achieved clinical union at the latest follow-up. Complications included radial palsy (n=1) and superficial wound infection (n=1). The postoperative VAS scores decreased significantly compared to preoperative score (F=257.99, P<0.01). Constant and Murley score increased and reached 81.33±0.95 at 24 months' follow-up 0=247.35, P<0.01). Among all the cases, 15 cases were graded as "excellent", and 9 as "good". In conclusion, Z-shaped osteotomy was easy to perform, and it provided additional medial support with more bone contact areas. Revision surgery using locking plate and Z-shaped osteotomy achieved high union rate and improved functional outcome. It was a reasonable and safe option for treating humeral nonunion following implant failure.展开更多
Osteogenesis imperfecta(OI) is a rare inherited connective tissue disorder caused by mutation of collagen which results in a wide spectrum of clinical manifestations including long bone fragility fractures and deformi...Osteogenesis imperfecta(OI) is a rare inherited connective tissue disorder caused by mutation of collagen which results in a wide spectrum of clinical manifestations including long bone fragility fractures and deformities. While the treatment for these fractures was recommended as using intramedullary fixation for minimizing stress concentration, the selection of the best implant in the adolescent OI patients for the surgical reconstruction of femur was still problematic, due to anatomy distortion and implant availability. We are reporting the surgical modification by using a humeral nail for femoral fixation in three adolescent OI patients with favorable outcomes.展开更多
Background： Glenohumeral internal rotation deficit （GIRD） is a risk factor for shoulder and elbow injury in baseball players. Although this evidence forms a basis for recommending stretching, clinical measures of i...Background： Glenohumeral internal rotation deficit （GIRD） is a risk factor for shoulder and elbow injury in baseball players. Although this evidence forms a basis for recommending stretching, clinical measures of internal rotation range of motion （ROM） do not differentiate if GIRD is due to muscular, capsuloligamentous, or osseous factors. Understanding the contributions of these structures to GIRD is important for the development of targeted interventions. We hypothesize that the osseous component will have the greatest relative contribution to GIRD, followed by muscle stiffness and posterior capsule thickness. Methods： Internal rotation ROM, muscle stiffness （teres minor, infraspinatus, and posterior deltoid）, posterior capsule thickness, and humeral retrotorsion were evaluated on 156 baseball players. A side-to-side difference was calculated for each variable. Variables were entered into a multivariable linear regression to determine the significant predictors of GIRD. Results： The regression model was statistically significant （R2 = 0.134, F（1, 156） = 24.0, p 〈 0.01） with only humeral retrotorsion difference remaining as a significant predictor （β = -0.243, t156 = -4.9, p 〈 0.01）. A greater humeral retrotorsion side-to-side difference was associated with more GIRD. Conclusion： Humeral retrotorsion accounted for 13.3% of the variance in GIRD. The stiffness of the superficial shoulder muscles and capsular thickness, as measured in this study, were not predictors of GIRD. Factors not assessed in this study, such as deeper muscle stiffness, capsule/ ligament laxity, and neuromuscular regulation of muscle stiffness may also contribute to GIRD. Since it is the largest contributor to GIRD, causes of changes in humeral retrotorsion need to be identified. The osseous component only accounted for 13.3% of the variance in GIRD, indicating a large contribution from soft tissues factors that were not addressed in this study. These factors need to be identified to develop evidence-based evaluations and intervention programs to decrease the risk of injury in baseball players.展开更多
AIM:To review outcomes following usage of the Ligament Advanced Reinforcement System(LARS?)in shoulder tumors.METHODS:Medical records of nineteen patients(19 shoulders)that underwent tumor excisional procedure and rec...AIM:To review outcomes following usage of the Ligament Advanced Reinforcement System(LARS?)in shoulder tumors.METHODS:Medical records of nineteen patients(19 shoulders)that underwent tumor excisional procedure and reconstruction with the LARS synthetic fabric,were retrospectively reviewed.RESULTS:Patients’median age was 58 years old,while the median length of resection was 110 mm(range 60-210 mm).Compared to immediate post-operative radiographs,the prosthesis mean end-point position migrated superiorly at a mean follow up period of 26 mo(P=0.002).No statistical significant correlations between the prosthesis head size(P=0.87);the implant stem body length(P=0.949);and the length of resection(P=0.125)with the position of the head,were found at last follow up.Two cases of radiological dislocation were noted but only one was clinically symptomatic.A minor superficial wound dehiscence,healed without surgery,occurred.There was no evidence of aseptic loosening either,and no prosthetic failure.CONCLUSION:LARS?use ensured stability of the shoulder following endoprosthetic reconstruction in most patients.展开更多
Objective: To explore a new strategy to treat humeral shaft nonunion efficiently. Methods: In the light of mechanical characteristics of Nickel Titanium memory and the anatomic morphology of humeral shaft, we designed...Objective: To explore a new strategy to treat humeral shaft nonunion efficiently. Methods: In the light of mechanical characteristics of Nickel Titanium memory and the anatomic morphology of humeral shaft, we designed the swan like shape memory alloy connector (SMC). SMC was clinically applied in treating 55 cases of humeral shaft nonunion. Success rate of nonunion repair, reinterventions, complications, range of motion, and patient satisfaction were evaluated. Results: Fifty five humeral shaft nonunion patients were treated with autogenous bone grafting and SMC internal fixation. The average follow up period was 32 months. In 50 patients with complete follow up data, 49 were recovered from nonunion by lamellar bone healing. The excellent and good rate was 98%; one patient suffering from re fracture in a fall refused further treatment. Neither infection nor re fracture after SMC extraction or joint dysfunction was found in the whole group. Conclusion: SMC facilitates safe internal fixation and bone grafting; its memory biomechanic properties promote osteosynthesis, resulting in accelerated and high quality healing of humeral shaft nonunion. SMC internal fixation with bone grafting is creative, efficient and promising in treating humeral shaft nonunion.展开更多
BACKGROUND Radial nerve palsy due to humeral shaft fracture is the most common peripheral nerve injury associated with long bone fractures.An antegrade nailing surgical technique is becoming popular for the fixation o...BACKGROUND Radial nerve palsy due to humeral shaft fracture is the most common peripheral nerve injury associated with long bone fractures.An antegrade nailing surgical technique is becoming popular for the fixation of these fractures with minimal invasiveness.We analyzed nerve recovery in patients with humeral shaft fracture and radial nerve palsy treated with humeral nail fixation without nerve exploration.AIM To assess the radial nerve recovery rate and time from humeral shaft fracture with surgical treatment using close nailing.METHODS We retrospectively collected data of patients who underwent undergone surgical nail fixation for humeral shaft fractures between October 1,2016,and March 31,2020.Subsequently,we analyzed the primary or secondary radial nerve palsy recovery rate and radial nerve motor function recovery time.RESULTS The study included 70 patients who underwent surgical treatment for closed-or Gustilo type I open humeral shaft fractures using a nail fixation technique without radial nerve exploration.The patients suffered from primary(n=5)and secondary(n=5)radial nerve palsy.A 100%radial nerve recovery rate was achieved.The mean recovery time was 4.3 mo.CONCLUSION The study results indicate full recovery of radial nerve palsies from humeral shaft fracture using close nailing treatment.Surgeons need not be concerned about the occurrence of permanent nerve palsies.展开更多
BACKGROUND Whether operation is superior to non-operation for humeral shaft fracture remains debatable.We hypothesized that operation could decrease the nonunion and reintervention rates and increase the functional ou...BACKGROUND Whether operation is superior to non-operation for humeral shaft fracture remains debatable.We hypothesized that operation could decrease the nonunion and reintervention rates and increase the functional outcomes.AIM To compare the clinical efficacy between operative and nonoperative approaches for humeral shaft fractures.METHODS We searched the PubMed,Web of Science,ScienceDirect,and Cochrane databases from 1990 to December 2023 for clinical trials and cohort studies comparing the effects of operative and conservative methods on humeral shaft fractures.Two investigators independently extracted data from the eligible studies,and the other two assessed the methodological quality of each study.The quality of the included studies was assessed using the Cochrane risk bias or Newcastle-Ottawa Scale.The nonunion,reintervention and the overall complications and functional scores were pooled and analyzed using Review Manager software(version 5.3).RESULTS A total of four randomized control trials and 13 cohort studies were included,with 1285 and 1346 patients in the operative and nonoperative groups,respectively.Patients in the operative group were treated with a plate or nail,whereas those in the conservative group were managed with splint or functional bracing.Four studies were assessed as having a high risk of bias,and the other 13 were of a low risk of bias according to the Newcastle-Ottawa Scale or Cochrane risk bias tool.The operative group had a significantly decreased rate of nonunion[odds ratio(OR)0.30;95%CI:0.23 to 0.40,reintervention(OR:0.33;95%CI:0.24 to 0.47),and overall complications(OR:0.62;95%CI:0.49 to 0.78)].The pooled effect of the Disabilities of Arm,Shoulder,and Hand score showed a significant difference at 3[mean difference(MD)-8.26;95%CI:-13.60 to-2.92],6(MD:-6.72;95%CI:-11.34 to-2.10),and 12 months(MD:-2.55;95%CI:-4.36 to-0.74).The pooled effect of Visual Analog Scale scores and the Constant-Murley score did not significantly differ between the two groups.CONCLUSION This systematic review and meta-analysis revealed a trend of rapid functional recovery and decreased rates of nonunion and reintervention after operation for humeral shaft fracture compared to conservative treatment.展开更多
The debate continues over the management of diaphyseal fractures of the humerus. There are a variety of extramedullary as well as intramedullary implants. We aim to propose a technique of passing the screw intramedull...The debate continues over the management of diaphyseal fractures of the humerus. There are a variety of extramedullary as well as intramedullary implants. We aim to propose a technique of passing the screw intramedullary nails and achieve union with least trauma to the shoulder and the rotator cuff. The multiple elastic screw nails achieve the inherent stability based on the principle of “three point fixation”. We aim to propose that the screw intramedullary nail is an effective implant to facilitate uneventful fracture union, with rapid recovery, low morbidity and low learning curve capable of being replicated in any smaller operative set up.展开更多
BACKGROUND Adult distal humeral fractures(DHF)comprise 2%-5%of all fractures and 30%of all elbow fractures.Treatment of DHF may be technically demanding due to fracture complexity and proximity of neurovascular struct...BACKGROUND Adult distal humeral fractures(DHF)comprise 2%-5%of all fractures and 30%of all elbow fractures.Treatment of DHF may be technically demanding due to fracture complexity and proximity of neurovascular structures.Open reduction and internal fixation(ORIF)are often the treatment of choice,but arthroplasty is considered in case of severe comminution or in elderly patients with poor bone quality.Ulnar nerve affection following surgical treatment of distal humerus fractures is a well-recognized complication.AIM To report the risk of ulnar nerve affection after surgery for acute DHFs.METHODS We retrospectively identified 239 consecutive adult patients with acute DHFs who underwent surgery with ORIF,elbow hemiarthroplasty(EHA)or total elbow arthroplasty(TEA)between January 2011 and December 2019.In all cases,the ulnar nerve was released in situ without anterior transposition.We used our institutional database to review patients’medical records for demographics,fracture morphology,type of surgery and ulnar nerve affection immediately;records were reviewed after surgery and at 2 wk and 12 wk of routine clinical outpatient follow-up.Twenty-nine percent patients were excluded due to pre-or postoperative conditions.Final follow-up examination was a telephone interview in which ulnar nerve affection was reported according to the McGowen Classification Score.A total of 210 patients were eligible for interview,but 13 patients declined participation and 17 patients failed to respond.Thus,180 patients were included.RESULTS Mean age at surgery was 64 years(range 18-88 years);121(67.3%)patients were women;59(32.7%)were men.According to the AO/OTA classification system,we recorded 47 patients with type A3,55 patients with type B and 78 patients with type C fractures.According to the McGowen Classification Score,mild ulnar nerve affection was reported in nine patients;severe affection,in two.A total of 69 patients were treated with ORIF of whom three had mild temporary ulnar nerve affection and one had severe ulnar nerve affection.In all,111 patients were treated with arthroplasty(67 EHA,44 TEA)of whom seven had mild ulnar nerve affection and one had severe persistent ulnar nerve affection.No further treatment was provided.CONCLUSION The risk of ulnar nerve affection after surgical treatment for acute DHF is low when the ulnar nerve is released in situ without nerve transposition,independently of the treatment provided.展开更多
In recent years, the measures on treatment of humeral epicondylitis with acupuncture and moxibustion were increased daily and a certain progression had been achieved. It had been synthesized in the paper various thera...In recent years, the measures on treatment of humeral epicondylitis with acupuncture and moxibustion were increased daily and a certain progression had been achieved. It had been synthesized in the paper various therapies of acupuncture and moxibustion in treatment of the disease, named filiform needling technique, special needling, warm needling and comprehensive therapy, as well as therapeutic evaluations and mechanisms. Additionally, the problems and shortcomings existed at present had been proposed in the paper.展开更多
In the present paper, the authors summarize their results of 30 cases of external humeral epicondylitis treated with thermal acupuncture of Chongyang (ST 42) and Ashi points. After 3-15 sessions of treatment, of the 3...In the present paper, the authors summarize their results of 30 cases of external humeral epicondylitis treated with thermal acupuncture of Chongyang (ST 42) and Ashi points. After 3-15 sessions of treatment, of the 30 cases, 24 (80%) were cured, and the rest 6 (20%) responded with apparent improvement in their symptoms.展开更多
AIM: To systematically review and analyze the overall impact and effectiveness of bony surgical procedures, the triangle tilt and humeral surgery in a comparative manner in permanent obstetric brachial plexus injury(O...AIM: To systematically review and analyze the overall impact and effectiveness of bony surgical procedures, the triangle tilt and humeral surgery in a comparative manner in permanent obstetric brachial plexus injury(OBPI) patients.METHODS: We conducted a literature search and identified original full research articles of OBPI patients treated with a secondary bony surgery, particularly addressing the limitation of shoulder abduction and functions. Further, we analyzed and compared the efficacy and the surgical outcomes of 9 humeral surgerypapers with 179 patients, and 4 of our secondary bony procedure, the triangle tilt surgical papers with 86 patients. RESULTS: Seven hundred and thirty-one articles were identified, using the search term "brachial plexus" and obstetric or pediatric(246 articles) or neonatal(219 articles) or congenital(188 articles) or "birth palsy"(121 articles). Further, only a few articles were identified using the bony surgery search, osteotomy "brachial plexus" obstetric(35), "humeral osteotomy" and "brachial plexus"(17), and triangle tilt "brachial plexus"(14). Of all, 12 studies reporting pre- and postoperative or improvement in total Mallet functional score were included in this study. Among these, 9 studies reported the humeral surgery and 4 were triangle tilt surgery. We used modified total Mallet functional score in this analysis. Various studies with humeral surgery showed improvement of 1.4, 2.3, 5.0 and 5.6 total Mallet score, whereas the triangle tilt surgery showed improvement of 5.0, 5.5, 6.0 and 6.2.CONCLUSION: The triangle tilt surgery improves on what was achieved by humeral osteotomy in the management of shoulder function in OBPI patients.展开更多
AIM To examine humeral retroversion in infants who sustained brachial plexus birth palsy(BPBI) and suffered from an internal rotation contracture. Additionally, the role of the infraspinatus(IS) and subscapularis(SSc)...AIM To examine humeral retroversion in infants who sustained brachial plexus birth palsy(BPBI) and suffered from an internal rotation contracture. Additionally, the role of the infraspinatus(IS) and subscapularis(SSc) muscles in the genesis of this bony deformation is explored.METHODS Bilateral magnetic resonance imaging(MRI) scans of 35 infants(age range: 2-7 mo old) with BPBI were retrospectively analyzed. Retroversion was measured according to two proximal axes and one distal axis(transepicondylar axis). The proximal axes were:(1) the perpendicular line to the borders of the articular surface(humeral centerline); and(2) the longest diameter through the humeral head. Muscle cross-sectional areas of the IS and SSc muscles were measured on the MRI-slides representing the largest muscle belly. The difference in retroversion was correlated with the ratio of muscle-sizes and passive external rotation measurements.RESULTS Retroversion on the involved side was significantly decreased, 1.0° vs 27.6°(1) and 8.5° vs 27.2°(2),(P < 0.01), as compared to the uninvolved side. The size of the SSc and IS muscles on the involved side was significantly decreased, 2.26 cm2 vs 2.79 cm2 and 1.53 cm2 vs 2.19 cm2, respectively(P < 0.05). Furthermore, the muscle ratio(SSc/IS) at the involved side was significantly smaller compared to the uninvolved side(P = 0.007).CONCLUSION Even in our youngest patient population, humeral retroversion has a high likelihood of being decreased. Altered humeral retroversion warrants attention as a structural change in any child being evaluated for the treatment of an internal rotation contracture.展开更多
基金approved by King Abdullah International Medical Research Center Ethics Committee(approval No.0000074524).
文摘BACKGROUND Humeral shaft fractures are common and vary by age,with high-energy trauma observed in younger adults and low-impact injuries in older adults.Radial nerve palsy is a frequent complication.Treatment ranges from nonoperative methods to surgical interventions such as intramedullary K-wires,which promote faster rehabilitation and improved elbow mobility.AIM To evaluate the outcomes of managing humeral shaft fractures using closed reduction and internal fixation with flexible intramedullary K-wires.METHODS This was a retrospective cohort study analyzing the medical records of patients with humeral shaft fractures managed with flexible intramedullary K-wires at King Abdulaziz Medical City,using non-random sampling and descriptive analysis for outcome evaluation.RESULTS This study assessed the clinical outcomes of 20 patients treated for humeral shaft fractures with intramedullary K-wires.Patients were predominantly male(n=16,80%),had an average age of 39.2 years,and a mean body mass index of 29.5 kg/m^(2).The fractures most frequently occurred in the middle third of the humerus(n=14,70%),with oblique fractures being the most common type(n=7,35%).All surgeries used general anesthesia and a posterior approach,with no intraoperative complications reported.Postoperatively,all patients achieved clinical and radiological union(n=20,100%),and the majority(n=13,65%)reached an elbow range of motion from 0 to 150 degrees.CONCLUSION These results suggest that intramedullary K-wire fixation may be an effective option for treating humeral shaft fractures,with favorable outcomes in range of motion recovery,fracture union,and a low rate of intraoperative complications.
文摘BACKGROUND Supracondylar humeral fractures are among the most common paediatric injuries.Displacement and consequent need for reduction impose operative treatment.Restoration of the anatomy of the distal part of the humerus prevents deformities and functional disorders of the elbow and upper limb.Stable K-wire fixation can be succeeded either by closed or open reduction method.AIM To investigate the safety and efficacy of open reduction method in the operative treatment of Gartland type III and IV supracondylar humeral fractures in children.METHODS We retrospectively studied 131 cases of paediatric supracondylar humerus fractures of Gartland type III-IV treated operatively by open reduction and pinning between 2001 and 2023 in our department.All patients underwent clinical and radiological examination recording elbow range of motion,function and deformity.RESULTS The standard lateral approach was carried out in all patients while in 47 cases(35.9%)additional medial approach was used.Average follow-up time was 5.4 years(1-14 years).Fracture healing was completed at 4-6 weeks.The average operative time was 50 min(range:37-75 minutes,SD:11.307)and the average duration of radiation exposure based on image intensifier usage time was 20 seconds(range:7-45 seconds,SD:9.864).No infections or iatrogenic neurovascular complications were recorded and the functional outcome regarding range of motion,Patient-Reported Outcome Measures(Disabilities of the Arm,Shoulder,and Hand questionnaire,Mayo Elbow Performance Scores)at 2-year follow-up was satisfying.CONCLUSION Open reduction and K-wire fixation provide very satisfactory outcome in supracondylar fractures of the humerus in children with reduced radiation burden.Moreover,the risk of neurovascular injuries due to manipulations of closed reduction,is minimized while complications related to surgical approaches are insignificant provided there is expertise.
文摘Operative management of humeral shaft fractures demonstrates superior early functional recovery(6-month Disabilities of the Arm,Shoulder,and Hand scores)and significantly lower nonunion rates(63.9%reduction)compared to functional bracing,particularly in complex cases,while conservative treatment remains viable for low-demand patients.Surgical techniques,including open reduction internal fixation,intramedullary nailing,and minimally invasive plate osteosynthesis,offer trade-offs between anatomic precision and complication risks(e.g.,radial nerve injury vs rotator cuff damage),with over 90%of radial nerve injuries resolving spontaneously.Ultrasound-guided diagnosis(89%sensitivity,95%specificity)optimizes decision-making for nerve entrapment.Individualized treatment selection,prioritizing fracture complexity and patient needs,is critical to balance accelerated rehabilitation with minimized complications.
基金Supported by Wuhu Municipal Science and Technology Bureau of Anhui Province,No.2022cg43.
文摘BACKGROUND The objective of this study was to evaluate the use of combined parallax-free panoramic X-ray imaging during surgery by enabling the mobile C-arm with minimally invasive plate osteosynthesis(MIPO)in the management of proximal humeral shaft fractures.AIM To evaluate parallax-free panoramic X-ray images during surgery.METHODS A retrospective series of 17 proximal humeral shaft fractures were treated using combined parallax-free panoramic X-ray imaging during surgery by enabling the mobile C-arm with MIPO.The operating time and radiation exposure time were recorded,and early postoperative physical therapy and partial weight bearing were encouraged.Patients were followed at regular intervals and evaluated radiographically and clinically.RESULTS The mean operating time and radiation time were 73(range,49-95)minutes and 57(range:36-98)seconds,respectively.No complications occurred during the operation.All fractures healed at an average of 16.9(range:15-23)weeks.The average Constant-Murley score for all the patients was 89.5(range:75-100)points.None of the patients showed symptoms of vascular or nerve damage or wound infection.Three months after the operation,none of the patients developed subacromial impingement syndrome.No loosening or fracture of the implants occurred.The frontal and lateral radiographs showed good alignment.CONCLUSION We consider that MIPO with combined parallax-free panoramic X-ray imaging during surgery is an efficient method for treating proximal humeral shaft fractures,and could significantly reduce operative morbidity as well as lower the rate of intra-and postoperative complications.
文摘Objective To observe the clinical effects of wrist-ankle acupuncture on external humeral epicondylitis. Methods Seventy-two cases diagnosed as external humeral epicondylitis were brought into the study. Horizontal needling was used at upper area 3, upper area 4 and upper area 5 near wrists with long filiform needles. The frequency was once a day, and a course included 10 times. Results 27 cases got cured, 36 cases were marked effective, 5 cases were effective and 4 cases were failed after 1 course to 5 courses of treatment. The total effective rate was 94.5%. Conclusion Wrist-ankle acupuncture is a simple and effective therapy on external humeral epicondylitis.
文摘OBJECTIVE:To compare two therapeutic methods:electroacupuncture + massage + blocking therapy,and blocking therapy alone in the treatment of external humeral epicondylitis.METHODS:Eighty-six patients were randomized into two groups with 43 in each. The treatment group received electroacupuncture + massage +blocking therapy, while the control group received blocking therapy only. A course of electroacupuncture treatment included therapy once a day for 10days. There were 10 treatments in a massage course and massage was given once a day, with a1-week interval given before the next course. A course of blocking treatment included therapy once a week, for twototaltreatments,andgenerallyno more than three times. The therapeutic effects were evaluated with the visual analog scale(VAS),grip strength index(GSI) score, and Mayo elbow performance score(MEPS) before treatment and at0, 6, 12, and 24 months after treatment to observe thetotaleffectiverate.RESULTS: In the treatment and control groups before treatment and at 0, 6, 12, and 24 months after treatment, the VAS scores were: 6.5±1.9 and 6.4±1.6; 4.6±1.3 and 4.6±1.7; 4.8±1.3 and 4.8±1.2; 4.6±1.2 and 6.6±1.6; and 6.5±1.6 and 6.5±1.3, respectively. The GSI scores were 63±8 and 63±8; 84±6and82±7;82±7and82±6;84±6and62±8;and64±6 and 64±7, respectively.The MEPS of both groups were65±7and66±8;85±6and84±7;84±5and84±7;80±7and66±6;and65±6and65±7,respectively.The total effective rates of the treatment and control groups at 0, 6, 12, and 24 months after treatment were 87.5% and 85.0%; 85.0% and 82.5%;80.0% and 12.5%; and 2.5% and 5.0%, respectively.Compared with the treatment group, the control group had greater joint function, better the rapeutic effect, and lower pain intensity(P<0.01), indicating a high recurrence rate in the 12th month after treatment.There were no differences inVAS, GSI, or MEPS at 0, 6, and 24 months after treatment(P>0.05)betweenthetwogroups.CONCLUSION: We found that both methods were effective for external humeral epicondylitis. After 6months of treatment,the effects were good in both groups. However, in the 12th month, the control group had a relatively severe relapse. After 24months, both groups relapsed. The effect of electroacupuncture, massage, and blocking therapy used in combination lasted longer, delaying the recurrence of the disease.
基金National Natural Science Foundation of China:81774402。
文摘Objective:To observe the clinical effect of electroacupuncture(EA)at Zhouling(Extra)and Ashi points in combination with blood-letting cupping for the treatment of external humeral epicondylitis(EHE).Methods:Thirty EHE patients were treated with EA at Zhouling(Extra)and Ashi points in combination with blood-letting cupping,once every 2 days,twice a week,4 times as one course of treatment,and2 successive courses of treatment were given.Before treatment,after 1 course of treatment,and after 2 courses of treatment,the visual analogue scale(VAS)score and Mayo elbow performance score(MEPS)were adopted to evaluate the curative effect.Results:Before treatment,the VAS score of patients was 7.81±1.39.After 1 course of treatment and after 2 courses of treatment,it was 4.77±1.56 and 2.95±1.23 respectively,lowered than before treatment,and the difference was statistically significant(both P<0.01).Before treatment,the Mayo score of patients was 32.17±19.31.After 1 course of treatment and after 2 courses of treatment,it was 47.39±19.85 and85.21±20.47 respectively,increased than before treatment,and the difference was statistically significant(both P<0.01).Of the 30 patients,5 were cured,accounting for 16.67%;14 cases obviously effective,accounting for 46.67%;8 cases effective,accounting for 26.67%;3 cases ineffective,accounting for 10.00%,and the total effective rate was 90.00%.Conclusion:EA at Zhouling(Extra)and Ashi points and blood-letting cupping used in combination are remarkably effective in the treatment of EHE,being worthy for popularization.
文摘Restoration of fracture alignment by osteotomy is crucial for the management of humeral nonunion. In the present study, we introduced a new way of osteotomy (Z-shaped) in treating humeral shaft nonunion secondary to failed plate osteosynthesis. Clinical data of 24 patients with humeral shaft nonunion following implant failure (from 2010 to 2014) were retrospectively evaluated. These patients underwent Z-shaped osteotomy in revision surgery after the initial surgery, plate osteosynthesis, was failed. Outcomes were evaluated using visual analogue scale (VAS) and Constant and Murley score. Repeated analysis of variance (ANOVA) was used for statistical analysis. Patients were followed up for a minimum of 24 months (26.83±4.33 months). The operative time was 102.33±10.16 min, and hospital stay averaged 9.75±2.13 days. All patients achieved clinical union at the latest follow-up. Complications included radial palsy (n=1) and superficial wound infection (n=1). The postoperative VAS scores decreased significantly compared to preoperative score (F=257.99, P<0.01). Constant and Murley score increased and reached 81.33±0.95 at 24 months' follow-up 0=247.35, P<0.01). Among all the cases, 15 cases were graded as "excellent", and 9 as "good". In conclusion, Z-shaped osteotomy was easy to perform, and it provided additional medial support with more bone contact areas. Revision surgery using locking plate and Z-shaped osteotomy achieved high union rate and improved functional outcome. It was a reasonable and safe option for treating humeral nonunion following implant failure.
文摘Osteogenesis imperfecta(OI) is a rare inherited connective tissue disorder caused by mutation of collagen which results in a wide spectrum of clinical manifestations including long bone fragility fractures and deformities. While the treatment for these fractures was recommended as using intramedullary fixation for minimizing stress concentration, the selection of the best implant in the adolescent OI patients for the surgical reconstruction of femur was still problematic, due to anatomy distortion and implant availability. We are reporting the surgical modification by using a humeral nail for femoral fixation in three adolescent OI patients with favorable outcomes.
文摘Background： Glenohumeral internal rotation deficit （GIRD） is a risk factor for shoulder and elbow injury in baseball players. Although this evidence forms a basis for recommending stretching, clinical measures of internal rotation range of motion （ROM） do not differentiate if GIRD is due to muscular, capsuloligamentous, or osseous factors. Understanding the contributions of these structures to GIRD is important for the development of targeted interventions. We hypothesize that the osseous component will have the greatest relative contribution to GIRD, followed by muscle stiffness and posterior capsule thickness. Methods： Internal rotation ROM, muscle stiffness （teres minor, infraspinatus, and posterior deltoid）, posterior capsule thickness, and humeral retrotorsion were evaluated on 156 baseball players. A side-to-side difference was calculated for each variable. Variables were entered into a multivariable linear regression to determine the significant predictors of GIRD. Results： The regression model was statistically significant （R2 = 0.134, F（1, 156） = 24.0, p 〈 0.01） with only humeral retrotorsion difference remaining as a significant predictor （β = -0.243, t156 = -4.9, p 〈 0.01）. A greater humeral retrotorsion side-to-side difference was associated with more GIRD. Conclusion： Humeral retrotorsion accounted for 13.3% of the variance in GIRD. The stiffness of the superficial shoulder muscles and capsular thickness, as measured in this study, were not predictors of GIRD. Factors not assessed in this study, such as deeper muscle stiffness, capsule/ ligament laxity, and neuromuscular regulation of muscle stiffness may also contribute to GIRD. Since it is the largest contributor to GIRD, causes of changes in humeral retrotorsion need to be identified. The osseous component only accounted for 13.3% of the variance in GIRD, indicating a large contribution from soft tissues factors that were not addressed in this study. These factors need to be identified to develop evidence-based evaluations and intervention programs to decrease the risk of injury in baseball players.
文摘AIM:To review outcomes following usage of the Ligament Advanced Reinforcement System(LARS?)in shoulder tumors.METHODS:Medical records of nineteen patients(19 shoulders)that underwent tumor excisional procedure and reconstruction with the LARS synthetic fabric,were retrospectively reviewed.RESULTS:Patients’median age was 58 years old,while the median length of resection was 110 mm(range 60-210 mm).Compared to immediate post-operative radiographs,the prosthesis mean end-point position migrated superiorly at a mean follow up period of 26 mo(P=0.002).No statistical significant correlations between the prosthesis head size(P=0.87);the implant stem body length(P=0.949);and the length of resection(P=0.125)with the position of the head,were found at last follow up.Two cases of radiological dislocation were noted but only one was clinically symptomatic.A minor superficial wound dehiscence,healed without surgery,occurred.There was no evidence of aseptic loosening either,and no prosthetic failure.CONCLUSION:LARS?use ensured stability of the shoulder following endoprosthetic reconstruction in most patients.
基金SupportedbyShanghaiYouthScienceandTechnologyRisingStarPlan (No .0 3QD1 4 0 6 9)
文摘Objective: To explore a new strategy to treat humeral shaft nonunion efficiently. Methods: In the light of mechanical characteristics of Nickel Titanium memory and the anatomic morphology of humeral shaft, we designed the swan like shape memory alloy connector (SMC). SMC was clinically applied in treating 55 cases of humeral shaft nonunion. Success rate of nonunion repair, reinterventions, complications, range of motion, and patient satisfaction were evaluated. Results: Fifty five humeral shaft nonunion patients were treated with autogenous bone grafting and SMC internal fixation. The average follow up period was 32 months. In 50 patients with complete follow up data, 49 were recovered from nonunion by lamellar bone healing. The excellent and good rate was 98%; one patient suffering from re fracture in a fall refused further treatment. Neither infection nor re fracture after SMC extraction or joint dysfunction was found in the whole group. Conclusion: SMC facilitates safe internal fixation and bone grafting; its memory biomechanic properties promote osteosynthesis, resulting in accelerated and high quality healing of humeral shaft nonunion. SMC internal fixation with bone grafting is creative, efficient and promising in treating humeral shaft nonunion.
文摘BACKGROUND Radial nerve palsy due to humeral shaft fracture is the most common peripheral nerve injury associated with long bone fractures.An antegrade nailing surgical technique is becoming popular for the fixation of these fractures with minimal invasiveness.We analyzed nerve recovery in patients with humeral shaft fracture and radial nerve palsy treated with humeral nail fixation without nerve exploration.AIM To assess the radial nerve recovery rate and time from humeral shaft fracture with surgical treatment using close nailing.METHODS We retrospectively collected data of patients who underwent undergone surgical nail fixation for humeral shaft fractures between October 1,2016,and March 31,2020.Subsequently,we analyzed the primary or secondary radial nerve palsy recovery rate and radial nerve motor function recovery time.RESULTS The study included 70 patients who underwent surgical treatment for closed-or Gustilo type I open humeral shaft fractures using a nail fixation technique without radial nerve exploration.The patients suffered from primary(n=5)and secondary(n=5)radial nerve palsy.A 100%radial nerve recovery rate was achieved.The mean recovery time was 4.3 mo.CONCLUSION The study results indicate full recovery of radial nerve palsies from humeral shaft fracture using close nailing treatment.Surgeons need not be concerned about the occurrence of permanent nerve palsies.
基金Supported by Natural Science Foundation of Chongqing,China,No.CSTB2023NSCQ-MSX1080.
文摘BACKGROUND Whether operation is superior to non-operation for humeral shaft fracture remains debatable.We hypothesized that operation could decrease the nonunion and reintervention rates and increase the functional outcomes.AIM To compare the clinical efficacy between operative and nonoperative approaches for humeral shaft fractures.METHODS We searched the PubMed,Web of Science,ScienceDirect,and Cochrane databases from 1990 to December 2023 for clinical trials and cohort studies comparing the effects of operative and conservative methods on humeral shaft fractures.Two investigators independently extracted data from the eligible studies,and the other two assessed the methodological quality of each study.The quality of the included studies was assessed using the Cochrane risk bias or Newcastle-Ottawa Scale.The nonunion,reintervention and the overall complications and functional scores were pooled and analyzed using Review Manager software(version 5.3).RESULTS A total of four randomized control trials and 13 cohort studies were included,with 1285 and 1346 patients in the operative and nonoperative groups,respectively.Patients in the operative group were treated with a plate or nail,whereas those in the conservative group were managed with splint or functional bracing.Four studies were assessed as having a high risk of bias,and the other 13 were of a low risk of bias according to the Newcastle-Ottawa Scale or Cochrane risk bias tool.The operative group had a significantly decreased rate of nonunion[odds ratio(OR)0.30;95%CI:0.23 to 0.40,reintervention(OR:0.33;95%CI:0.24 to 0.47),and overall complications(OR:0.62;95%CI:0.49 to 0.78)].The pooled effect of the Disabilities of Arm,Shoulder,and Hand score showed a significant difference at 3[mean difference(MD)-8.26;95%CI:-13.60 to-2.92],6(MD:-6.72;95%CI:-11.34 to-2.10),and 12 months(MD:-2.55;95%CI:-4.36 to-0.74).The pooled effect of Visual Analog Scale scores and the Constant-Murley score did not significantly differ between the two groups.CONCLUSION This systematic review and meta-analysis revealed a trend of rapid functional recovery and decreased rates of nonunion and reintervention after operation for humeral shaft fracture compared to conservative treatment.
文摘The debate continues over the management of diaphyseal fractures of the humerus. There are a variety of extramedullary as well as intramedullary implants. We aim to propose a technique of passing the screw intramedullary nails and achieve union with least trauma to the shoulder and the rotator cuff. The multiple elastic screw nails achieve the inherent stability based on the principle of “three point fixation”. We aim to propose that the screw intramedullary nail is an effective implant to facilitate uneventful fracture union, with rapid recovery, low morbidity and low learning curve capable of being replicated in any smaller operative set up.
文摘BACKGROUND Adult distal humeral fractures(DHF)comprise 2%-5%of all fractures and 30%of all elbow fractures.Treatment of DHF may be technically demanding due to fracture complexity and proximity of neurovascular structures.Open reduction and internal fixation(ORIF)are often the treatment of choice,but arthroplasty is considered in case of severe comminution or in elderly patients with poor bone quality.Ulnar nerve affection following surgical treatment of distal humerus fractures is a well-recognized complication.AIM To report the risk of ulnar nerve affection after surgery for acute DHFs.METHODS We retrospectively identified 239 consecutive adult patients with acute DHFs who underwent surgery with ORIF,elbow hemiarthroplasty(EHA)or total elbow arthroplasty(TEA)between January 2011 and December 2019.In all cases,the ulnar nerve was released in situ without anterior transposition.We used our institutional database to review patients’medical records for demographics,fracture morphology,type of surgery and ulnar nerve affection immediately;records were reviewed after surgery and at 2 wk and 12 wk of routine clinical outpatient follow-up.Twenty-nine percent patients were excluded due to pre-or postoperative conditions.Final follow-up examination was a telephone interview in which ulnar nerve affection was reported according to the McGowen Classification Score.A total of 210 patients were eligible for interview,but 13 patients declined participation and 17 patients failed to respond.Thus,180 patients were included.RESULTS Mean age at surgery was 64 years(range 18-88 years);121(67.3%)patients were women;59(32.7%)were men.According to the AO/OTA classification system,we recorded 47 patients with type A3,55 patients with type B and 78 patients with type C fractures.According to the McGowen Classification Score,mild ulnar nerve affection was reported in nine patients;severe affection,in two.A total of 69 patients were treated with ORIF of whom three had mild temporary ulnar nerve affection and one had severe ulnar nerve affection.In all,111 patients were treated with arthroplasty(67 EHA,44 TEA)of whom seven had mild ulnar nerve affection and one had severe persistent ulnar nerve affection.No further treatment was provided.CONCLUSION The risk of ulnar nerve affection after surgical treatment for acute DHF is low when the ulnar nerve is released in situ without nerve transposition,independently of the treatment provided.
文摘In recent years, the measures on treatment of humeral epicondylitis with acupuncture and moxibustion were increased daily and a certain progression had been achieved. It had been synthesized in the paper various therapies of acupuncture and moxibustion in treatment of the disease, named filiform needling technique, special needling, warm needling and comprehensive therapy, as well as therapeutic evaluations and mechanisms. Additionally, the problems and shortcomings existed at present had been proposed in the paper.
文摘In the present paper, the authors summarize their results of 30 cases of external humeral epicondylitis treated with thermal acupuncture of Chongyang (ST 42) and Ashi points. After 3-15 sessions of treatment, of the 30 cases, 24 (80%) were cured, and the rest 6 (20%) responded with apparent improvement in their symptoms.
文摘AIM: To systematically review and analyze the overall impact and effectiveness of bony surgical procedures, the triangle tilt and humeral surgery in a comparative manner in permanent obstetric brachial plexus injury(OBPI) patients.METHODS: We conducted a literature search and identified original full research articles of OBPI patients treated with a secondary bony surgery, particularly addressing the limitation of shoulder abduction and functions. Further, we analyzed and compared the efficacy and the surgical outcomes of 9 humeral surgerypapers with 179 patients, and 4 of our secondary bony procedure, the triangle tilt surgical papers with 86 patients. RESULTS: Seven hundred and thirty-one articles were identified, using the search term "brachial plexus" and obstetric or pediatric(246 articles) or neonatal(219 articles) or congenital(188 articles) or "birth palsy"(121 articles). Further, only a few articles were identified using the bony surgery search, osteotomy "brachial plexus" obstetric(35), "humeral osteotomy" and "brachial plexus"(17), and triangle tilt "brachial plexus"(14). Of all, 12 studies reporting pre- and postoperative or improvement in total Mallet functional score were included in this study. Among these, 9 studies reported the humeral surgery and 4 were triangle tilt surgery. We used modified total Mallet functional score in this analysis. Various studies with humeral surgery showed improvement of 1.4, 2.3, 5.0 and 5.6 total Mallet score, whereas the triangle tilt surgery showed improvement of 5.0, 5.5, 6.0 and 6.2.CONCLUSION: The triangle tilt surgery improves on what was achieved by humeral osteotomy in the management of shoulder function in OBPI patients.
文摘AIM To examine humeral retroversion in infants who sustained brachial plexus birth palsy(BPBI) and suffered from an internal rotation contracture. Additionally, the role of the infraspinatus(IS) and subscapularis(SSc) muscles in the genesis of this bony deformation is explored.METHODS Bilateral magnetic resonance imaging(MRI) scans of 35 infants(age range: 2-7 mo old) with BPBI were retrospectively analyzed. Retroversion was measured according to two proximal axes and one distal axis(transepicondylar axis). The proximal axes were:(1) the perpendicular line to the borders of the articular surface(humeral centerline); and(2) the longest diameter through the humeral head. Muscle cross-sectional areas of the IS and SSc muscles were measured on the MRI-slides representing the largest muscle belly. The difference in retroversion was correlated with the ratio of muscle-sizes and passive external rotation measurements.RESULTS Retroversion on the involved side was significantly decreased, 1.0° vs 27.6°(1) and 8.5° vs 27.2°(2),(P < 0.01), as compared to the uninvolved side. The size of the SSc and IS muscles on the involved side was significantly decreased, 2.26 cm2 vs 2.79 cm2 and 1.53 cm2 vs 2.19 cm2, respectively(P < 0.05). Furthermore, the muscle ratio(SSc/IS) at the involved side was significantly smaller compared to the uninvolved side(P = 0.007).CONCLUSION Even in our youngest patient population, humeral retroversion has a high likelihood of being decreased. Altered humeral retroversion warrants attention as a structural change in any child being evaluated for the treatment of an internal rotation contracture.
